Testosterone Drug Interactions: Which Medicines Matter and What to Do

Testosterone drug interactions often need monitoring, not an automatic ban. Testosterone can change warfarin's effect, lower blood sugar, and add to corticosteroid-related fluid retention. Some products also flag medicines that raise blood pressure. The exact testosterone product, your other medicines, and why you take them decide what needs checking. ^{4 13}

By TRT Provider Guide · Last verified: October 2026 · Sources checked October 27, 2026 · Editorial research based on prescribing information and clinical guidelines; not clinically reviewed.

Last updated: October 27, 2026.

But if you take a blood thinner, testosterone's own clot warning and effect on red blood cell counts still matter. Checking for a drug interaction is only part of that decision. ⁷

What changes your answer:

• which blood thinner you take, and why you take it
• your diabetes medicines
• your blood pressure
• which testosterone product you use, because the labels are not identical

The good news first: several labeled interactions mean watch closely, not never combine. That is not personal clearance to use the combination. ⁴

Use this page if you are a U.S. adult man taking testosterone, or thinking about TRT for testosterone deficiency, and you also take a prescription medicine, an over-the-counter drug, or a supplement. Other populations need their own treatment guidance.

Don't use this page to start, stop, or change any medicine on your own. That includes testosterone, blood thinners, insulin, and steroids.

Educational information, not medical advice. Call 911 for sudden shortness of breath, chest pain, coughing up blood, stroke symptoms, or severe bleeding that will not stop. A new swollen, painful or warm leg needs urgent medical assessment; do not wait for a routine TRT visit. ^{48 17}

TRT Provider Guide is the independent decision resource for testosterone replacement therapy — helping U.S. adults understand how low testosterone is evaluated, compare online and local care models and providers, and choose the next step that fits their health needs, fertility plans, budget, state, and care preferences, with every material claim verified and dated.

---

Which testosterone drug interactions need monitoring?

The main recurring warnings in the testosterone labels reviewed concern oral anticoagulants, blood sugar and corticosteroids such as prednisone. Some products add medicines that raise blood pressure, and Natesto adds other nasal medicines. A drug-checker list and a product label serve different purposes; neither replaces a review of your full medication list. ^{4 12 13}

The three recurring interaction groups

1. Warfarin and similar blood thinners. Testosterone can change how strongly warfarin works. Current labels tell prescribers to check INR more often, especially when testosterone starts or stops. INR is a standardized result calculated from prothrombin time (PT), a test of how long blood takes to clot. It does not measure blood thickness. ^{4 13}

2. Insulin and other diabetes medicines. Testosterone can make your body more sensitive to insulin. That can push blood sugar down. Labels say diabetes medicine doses may need to come down. Your diabetes prescriber decides that, not you. ⁷

3. Corticosteroids. These are anti-inflammatory steroids like prednisone, methylprednisolone, and dexamethasone. They are not the same as anabolic steroids. Corticosteroids and testosterone can both make your body hold on to water. Together, that can mean more swelling. Labels ask for careful monitoring, especially if you have heart, kidney, or liver disease. ^{4 12}

Why drug checkers show 196 interactions

Type "testosterone" into a big interaction database and you'll see a scary number. Drugs.com showed 196 interactions in October 2026, 13 of them labeled major. Mayo Clinic's list includes apixaban (Eliquis), rivaroxaban (Xarelto), bupropion, methotrexate, and more. ^{50 51}

Those databases are doing a different job. Their lists are not limited to the interaction section of one product label. A flag needs a drug-specific explanation; an absent flag is not proof of safety. This review does not claim to know each database's unpublished classification rules.

That's why we built this page from the labels, then added relevant research and common medication questions. You get the recurring warnings, the important differences, and what still needs a pharmacist or prescriber to check.

"Interaction" doesn't mean "you can't take it"

An interaction means two drugs can change each other's effects. The response may be closer checks, a treatment change by your prescriber, or avoiding the combination. ^{4 12}

A contraindication is different. It means a drug shouldn't be used in a certain situation at all.

Several testosterone interactions on this page call for watching a number more closely: INR, blood sugar, blood pressure, or hematocrit. Others need a product-specific decision, such as Natesto with another nasal medicine. ^{4 12 25}

The right TRT provider is not the same for every person — it depends on whether low testosterone has been properly evaluated, your symptoms and health history, your fertility plans, your state, your insurance or cash-pay preference, your treatment-format preference, your budget, and whether online or in-person care is the better starting point. Some situations belong with primary care, urology, endocrinology, reproductive urology, or urgent or emergency care when the symptoms warrant it. Because a general answer cannot resolve those for you, use TRT Provider Guide's Find My TRT Path tool as an educational starting point for care options, and bring your medication questions to a clinician before you pay. The tool is educational and non-diagnostic; it cannot check drug interactions or clear you for treatment.

---

Can you take testosterone with blood thinners?

Testosterone and a blood thinner are not automatically incompatible, but the exact medicine and the reason you take it matter. Warfarin has a labeled interaction that calls for closer INR checks. Eliquis and Xarelto need their own medication review—not a copied warfarin plan—and testosterone's clot and hematocrit warnings still matter. ^{4 17 18 7}

"Blood thinner" covers three very different kinds of drugs. Do not apply warfarin's INR instructions to Eliquis: routine PT/INR testing is not useful for measuring Eliquis's anticoagulant effect. ¹⁷

Here's the clean version.

Sources: ^{1 4 13 17 18}.

Testosterone and warfarin: what the label says

This is the best-documented testosterone interaction. Current labels for Xyosted, Aveed, AndroGel, Jatenzo, and others tell prescribers to check INR and prothrombin time more often, especially when testosterone therapy begins and when it ends. The Depo-Testosterone label says androgens may increase sensitivity to oral anticoagulants, and the anticoagulant dose may need to come down under clinician supervision. ^{1 4 5 7 13}

How big can the effect be? A historical oxandrolone label reports an approximately 80–85% reduction in warfarin requirements in 15 healthy participants. That was a different anabolic steroid, not testosterone. It cannot predict your response to TRT or tell you how to change warfarin. The testosterone label calls for monitoring rather than a fixed percentage adjustment. ^{49 4}

The label does not give a formula for predicting an individual's response. You don't need a mechanism to act on the warning. The practical point is simple:

If you take warfarin, your warfarin prescriber needs to know the date testosterone starts, and the date it stops or changes. Those changes need a fresh monitoring plan. ⁴

Testosterone and Eliquis or Xarelto

The labels reviewed do not name a testosterone–apixaban or testosterone–rivaroxaban interaction. That is a limited finding, not proof the combinations have no interaction. Testosterone labels may use broad wording such as 'oral anticoagulants'; the current Eliquis and Xarelto interaction sections focus on other named drug groups. ^{1 4 17 18}

So why do some interaction lists flag the combination? Their displayed warning alone does not establish a warfarin-style effect or explain the evidence behind it. Ask the pharmacist to check the specific drug and evidence rather than assuming the alert is either meaningless or a ban.

A second question for DOAC users is "why am I on Eliquis, and does testosterone's clot warning matter for me?" Do not assume an anticoagulant cancels out every TRT risk. We cover that in the sections below. ^{7 17}

What about aspirin or Plavix?

Aspirin and clopidogrel are antiplatelets. They make platelets less sticky. Warfarin and DOACs work on other parts of the clotting process; none literally makes blood thinner. Antiplatelets are not substitutes for a prescribed anticoagulant. ^{17 18}

Two things matter here.

• Aspirin doesn't lower hematocrit. Hematocrit is the percentage of your blood made of red blood cells. TRT can push it up. Taking aspirin doesn't bring it down. If your hematocrit runs high, that's a job for your prescriber, not the medicine cabinet. ²⁰
• Stacking adds bleeding risk. Both the Eliquis and Xarelto labels warn that adding aspirin or other antiplatelets raises bleeding risk. If you take an anticoagulant, don't add aspirin on your own because you started TRT. ^{17 18}

If you take a blood thinner because of a past clot

This is where we'll be blunt.

If you're on warfarin or a DOAC because you had a deep vein thrombosis (DVT), a pulmonary embolism (PE), or you have a clotting disorder, testosterone needs a specialist conversation before anything else. The reasons:

• The Endocrine Society's guideline recommends against starting testosterone in men with thrombophilia, a condition that increases clotting risk. A past clot is not automatically the same diagnosis. ¹⁹
• Current testosterone labels warn about deep vein thrombosis and pulmonary embolism. ^{1 7}
• In the large TRAVERSE trial, pulmonary embolism was more common on testosterone (0.9%) than on placebo (0.5%). ⁷

A past clot needs an individual risk assessment; known thrombophilia carries a specific guideline recommendation against starting testosterone. An online TRT intake form is the wrong starting point for resolving that risk. Start with the hematologist or anticoagulation prescriber who knows why your clot happened. Our guide to who should not take TRT explains the other situations that need that same specialist-first approach. ¹⁹

If you take a blood thinner for AFib or a heart valve

This can be a different situation from a past DVT or PE. Anticoagulation for atrial fibrillation helps prevent stroke; a heart-valve indication needs its own review. Do not treat mechanical-valve anticoagulation as a routine DOAC situation. Eliquis and Xarelto labels do not recommend use in patients with prosthetic heart valves. ^{17 18}

One finding still matters. In TRAVERSE, atrial fibrillation happened in 3.5% of men on testosterone versus 2.4% on placebo. Your cardiologist should hear about TRT before you start, not after. This was a trial in men with existing cardiovascular disease or increased cardiovascular risk, not a study of every person with AFib. ^{21 7}

Injections while you're on a blood thinner

The evidence quoted here comes from vaccines, not testosterone injections. A 2022 review pooled 642 anticoagulated patients, mostly taking warfarin, who received intramuscular vaccines. The pooled hematoma rate was about 0.46%, with no major bleeding reported. The review had no DOAC data and does not establish the risk of repeated testosterone injections. ²⁸

If needle bleeding worries you, ask your prescriber whether a different treatment format makes more sense for you. Gels, oral capsules, and under-the-skin injections like Xyosted exist. No alternative here is being declared safer for your anticoagulant. That's a question to raise, not a switch to make on your own. ^{7 13 4}

Warning signs to know

Possible bleeding:

• black, tarry, or bloody stool
• pink, red, or brown urine
• vomiting blood
• nosebleeds that won't stop
• bruising you can't explain

Possible clot:

• swelling, pain, or warmth in one leg
• sudden shortness of breath
• chest pain
• coughing up blood

Call 911 for chest pain, sudden shortness of breath, coughing up blood, stroke symptoms, or severe bleeding that will not stop. A new swollen, painful or warm leg needs urgent assessment. Blood in stool, urine or vomit, or new unexplained bruising while on an anticoagulant needs prompt medical advice; heavy bleeding, faintness or collapse is an emergency. ^{48 17}

On a blood thinner and not sure where TRT fits? Bring the questions above to your anticoagulation prescriber first. For general care-route questions, use TRT Provider Guide's Find My TRT Path tool. It cannot assess your clot risk or approve a drug combination. Explore TRT care questions →

---

Can testosterone cause blood clots?

FDA labels warn about blood clots in the legs and lungs. In TRAVERSE, venous clots were numerically more common with testosterone gel than placebo, although the trial did not find a higher rate of its main heart-attack, stroke and cardiovascular-death outcome. A past clot or thrombophilia needs its own assessment; studies do not establish one risk level or timeline for everyone. ^{7 21 19}

What the numbers show

Here's what the different kinds of evidence show:

• TRAVERSE (New England Journal of Medicine, 2023). The trial randomized 5,246 men aged 45 to 80 with symptoms, repeatedly low testosterone, and existing or increased cardiovascular risk to testosterone gel or placebo. Average treatment lasted about 22 months; average follow-up was about 33 months. Current labels report venous clots (VTE) in 1.7% on testosterone versus 1.2% on placebo, and pulmonary embolism in 0.9% versus 0.5%. The main cardiovascular outcome occurred in 7.0% versus 7.3%. The gel results do not establish identical risks for every testosterone product. ^{21 7}
• A U.K. study (BMJ, 2016) of more than 19,000 clot cases found an association concentrated in the first six months of testosterone use. The estimated excess was about 10 clots per 10,000 person-years during that early-use window—an annualized rate, not 10 clots in six months among 10,000 treated men. It was observational and cannot by itself prove causation. ²²
• A 2024 review including 14 randomized trials found no statistically clear increase in VTE in its randomized evidence. Wide confidence intervals mean that finding cannot rule out a clinically important risk. ²³

The Endocrine Society's July 2026 statement also flags pulmonary embolism. For the absolute figures reported in current labels, about 5 in 1,000 placebo patients and 9 in 1,000 testosterone patients had a PE. That is about four additional pulmonary embolisms per 1,000 patients over the trial's follow-up, not an annual rate. ^{43 7}

Clots and "thick blood" are two different problems

People often blend these together. They're separate.

Problem 1: clot risk is not measured by hematocrit alone. Testosterone labels discuss VTE and high hematocrit as separate warnings. A normal hematocrit is not a test that rules out a blood clot. ^{7 48}

Problem 2: thick blood. Testosterone raises red blood cell production. When hematocrit climbs too high, doctors call it erythrocytosis (also called polycythemia). A 2022 observational study in the Journal of Urology found more first-year cardiovascular or venous-clot events among TRT users who developed secondary polycythemia than among those who did not. It found an association, not proof that hematocrit alone caused the events. ²⁴

Here's how the guidelines handle hematocrit:

• Before treatment: The Endocrine Society treats hematocrit above 48%—or above 50% at high altitude—as a reason for further evaluation before TRT.
• During treatment: Its guideline directs clinicians to intervene when hematocrit exceeds 54%, evaluate causes such as low oxygen or sleep apnea, and decide whether and how therapy can resume. These are clinical action thresholds, not instructions to change treatment yourself. ²⁰

"How do I thin my blood while on testosterone?"

We get why people search this. Their hematocrit came back high and they want to fix it fast.

Don't treat it yourself. Aspirin and "blood-thinning" supplements are not guideline treatments for TRT-related high hematocrit. Adding aspirin to an anticoagulant can raise bleeding risk. ¹⁷ Clinical management may include changing or pausing testosterone, addressing another cause, or phlebotomy (a blood draw to remove red cells), all decided by your prescriber. Do not use blood donation as a substitute for finding and treating the cause. ²⁰

If you take one of the diabetes medicines in the next section, mention that too. One drug class makes this problem more likely.

---

Does testosterone interact with diabetes medicines?

Yes. The testosterone records reviewed warn that blood glucose and diabetes-treatment needs can change. SGLT2 inhibitors such as Jardiance add a second issue: an observational study found higher odds of erythrocytosis with combined treatment than with either drug class alone. ^{1 7 25}

Insulin and other glucose-lowering medicines

Testosterone can improve how your body responds to insulin. That sounds good, and sometimes it is. But if you already take insulin or a sulfonylurea, a change in glucose control can increase the chance of low blood sugar. Not all diabetes medicines carry the same hypoglycemia risk. ^{7 31}

The labels say the dose of anti-diabetic medicine may need to come down. In practice:

• Ask your diabetes prescriber whether glucose checks need to be more frequent after testosterone starts or changes.
• Let your diabetes prescriber know the start date.
• Don't adjust insulin yourself based on a hunch. Bring them your readings.

One more point from the Endocrine Society: it does not recommend testosterone as a way to control blood sugar in men with type 2 diabetes. TRT treats appropriately diagnosed testosterone deficiency. It isn't a diabetes medicine. ¹⁹

What about metformin?

The testosterone labels reviewed do not name metformin specifically. The broader glucose-control warning still belongs in your medication review. Metformin alone rarely causes low blood sugar, so the bigger concern is if you take it alongside insulin or a sulfonylurea. Tell your diabetes prescriber about your whole regimen. ^{7 57}

Jardiance, Farxiga, and hematocrit: the overlap most pages miss

SGLT2 inhibitors include empagliflozin (Jardiance), dapagliflozin (Farxiga), and canagliflozin (Invokana). Their approved uses differ by product and include diabetes and certain heart or kidney conditions. ⁵⁸ A meta-analysis found an average hematocrit increase of about 2.3 percentage points with SGLT2 inhibitors. ²⁶

TRT raises hematocrit too. That overlap makes the combination worth monitoring, rather than assuming the effects are the same for every patient. ^{7 25}

The evidence:

• Case series (2022). Doctors described five men on long-term TRT who developed erythrocytosis after empagliflozin was added. It resolved after clinician-directed changes to testosterone or phlebotomy. This was a small case series, not a treatment protocol. ²⁷
• Veterans study (2024). Researchers looked at 53,971 U.S. veterans with type 2 diabetes. Men on both drugs had adjusted odds of erythrocytosis (hematocrit above 54% within one year) about 3.8 times those with an SGLT2 inhibitor alone, and about 2.5 times those with TRT alone. These are odds ratios from an observational study, not the chance that an individual patient will develop the problem. ²⁵

What to do: If you're on TRT and start Jardiance or Farxiga, or the other way around, ask who will check your baseline hematocrit and when it should be repeated. The Endocrine Society recommends a hematocrit check before TRT, at 3–6 months, and then annually; your clinician may choose a different interval for your risks or product. ^{20 25}

Ozempic, Mounjaro, and Zepbound

The labels reviewed do not establish a testosterone-specific interaction with semaglutide or tirzepatide. That is not the same as 'fine to combine.' Semaglutide is a GLP-1 receptor agonist; tirzepatide acts at both GIP and GLP-1 receptors. Their labels warn about delayed stomach emptying and possible effects on oral medicines. Mounjaro specifically calls for monitoring certain oral drugs with a narrow therapeutic index, such as warfarin. ^{31 32}

Tell both prescribers, particularly if you use oral testosterone, warfarin, insulin or a sulfonylurea. A clinically important change in oral-testosterone absorption is not established by these labels; that question needs product-specific review.

There's also a finding worth knowing. In a 2025 conference report of 110 men using GLP-1-based medicines without testosterone or other hormone therapy, the share with normal total and free testosterone rose from 53% to 77% as they lost weight. This was observational, not proof that the drugs directly restored testosterone or that every man can replace TRT with weight loss. Ask whether a major weight change calls for reassessment. Our guide to TRT and GLP-1 medicines covers this in depth. ³³

---

Can you take prednisone with testosterone?

Prednisone and testosterone are sometimes prescribed together, but their fluid-retention effects need review. Twelve of the 15 testosterone records below explicitly name corticosteroids; the other three do not list the combination in their interaction section. Watch for swelling in your ankles, feet, or legs, especially if you have heart, kidney, or liver disease. ^{4 7 12}

What the labels say

Most current labels say that combining testosterone with corticosteroids, or with ACTH (a hormone that tells your body to make its own steroids), may increase fluid retention. They ask for careful monitoring, particularly in people with heart, kidney, or liver disease. ^{4 7}

What a missing interaction entry means

In our sample, Depo-Testosterone, the selected generic testosterone cypionate record and Testopel do not explicitly name the combination in the drug-interaction section. The separate methyltestosterone comparator also lacks that entry. That describes the records we read; it does not explain why the wording differs. ^{1 2 6 16}

Our editorial view: a missing entry is not a reason to skip the fluid-retention discussion. The older-format records also describe androgen-related fluid retention, so the prescriber should review the actual combination. ^{1 6}

Short courses, inhalers, and creams

A short prednisone course and years of daily steroids aren't the same exposure. Do not treat an inhaler, a skin cream, a nasal spray or a joint injection as identical to an oral course—or assume a locally applied steroid has no body-wide effects. Tell your clinician the exact product, how it is used, and how often.

You don't need to panic about any of them. Just tell your TRT prescriber what you use and how often.

If you're already dealing with puffiness or swelling on TRT, report it rather than assuming it is harmless. Sudden breathing trouble needs emergency care. ^{4 48}

---

Does testosterone interact with blood pressure medicine?

There is no blanket rule that blood pressure treatment and testosterone cannot be used together. Testosterone itself can raise blood pressure, and some products warn that other BP-raising medicines can add to that effect. Have the pharmacist check your exact medicines rather than treating all blood pressure drugs as one interaction category. ^{41 4 13}

Testosterone can raise blood pressure

In February 2025, the FDA announced class-wide label changes after ambulatory blood-pressure studies confirmed increased blood pressure with testosterone products. The agency requested product-specific study information where available and a blood-pressure warning across the class. That does not mean every product was tested in the same study. ⁴¹

Here's what each product's own 24-hour monitoring study found. These are average rises in systolic pressure (the top number):

Source: the linked prescribing information for each product, checked October 27, 2026. These are mean changes from baseline in separate ambulatory blood-pressure studies, not a head-to-head comparison or a ranking. Participants and study designs differed.

A few points on the top number might sound small. The labels treat that as a clinically relevant concern and do not recommend these products in patients with uncontrolled hypertension. Your clinician should review blood pressure before and during treatment. ^{4 13 15}

Decongestants and pain relievers

The Xyosted, Jatenzo, Tlando, and Kyzatrex labels go a step further. They warn that some prescription drugs and some over-the-counter pain and cold medicines can raise blood pressure, and that combining them with testosterone may raise it more. ^{4 13 14 15}

The common culprits:

• Decongestants: pseudoephedrine and phenylephrine, found in many "D" cold and allergy products
• NSAID pain relievers: ibuprofen, naproxen

These medicine groups can raise blood pressure; check the active ingredients rather than relying on the brand name. ⁵⁹

That doesn't mean you can never take Advil for a sore back. It means the exact medicine and frequency deserve a conversation. Ask your clinician whether home blood-pressure readings would help.

If you already take blood pressure medicine

Do not stop a prescribed blood pressure medicine to make room for TRT. The combination needs drug-specific review, not a blanket 'they don't clash' promise.

What changes is the bigger picture. TRT may nudge your numbers up, so your clinician may need to review the treatment that controlled them before. Agree on a monitoring plan and share your readings at follow-ups. ^{4 13}

---

Do testosterone drug interactions change by product?

Yes. We compared 15 selected U.S. testosterone prescribing-information records and kept methyltestosterone as a separate related-androgen comparator. The testosterone records share oral-anticoagulant and blood-sugar warnings, but their other entries differ; this is a label comparison, not a census of everything currently sold.

This is the table we wish existed when we started. It brings the interaction sections together with a direct source for every record. A check mark means the section names the issue—not that other products are free of that risk.

The Testosterone Label Interaction Matrix (October 2026): 15 records plus one separate comparator

Separate related androgen—not a testosterone formulation:

✓ = explicitly named in the drug-interaction section; — = not explicitly named there, not proof of no interaction. “Oral anticoagulants” includes broad older wording and more specific warfarin/VKA wording in newer records. Generic rows identify the particular linked record, not every manufacturer. Revision dates refer to the prescribing information unless marked as a DailyMed update. TRAVERSE was a testosterone-gel trial; a label citing it does not mean its own product was tested in that trial. This table does not establish current retail availability or count discontinued brands.

What the matrix tells you

A shorter interaction section does not mean a safer product. The linked Depo-Testosterone, generic injection, Testopel and methyltestosterone records use different wording from the newer-format labels and do not reproduce the TRAVERSE results. A missing entry does not mean the risk is missing.

Your pharmacist and your clinic may be using different references. If you get a warning from one and not the other, ask which product label and interaction evidence each used. Do not dismiss the warning because one list is shorter.

Propranolol is not named in these 16 records. That finding is limited to this sample and does not clear a particular propranolol–testosterone combination.

Oxyphenbutazone appears in the older-format records. We kept the entry so the comparison reflects what those records actually say. If it appears on a medication list, ask the pharmacist to review it rather than ignoring the label warning. ^{1 3 6 16}

Does testosterone gel interact differently than injections?

Gels, injections, and pellets overlap on oral-anticoagulant and glucose warnings. Many records also name corticosteroids. That overlap does not make every formulation or monitoring plan interchangeable. ^{7 4 6}

The real differences are about product, not form. For example, Xyosted (an injection) lists blood-pressure-raising drugs, but Depo-Testosterone (also an injection) doesn't. Bring your exact product name to any medication review, not just "TRT."

Oral testosterone: Jatenzo, Tlando, and Kyzatrex

All three oral testosterone undecanoate products list the full set: insulin, warfarin, corticosteroids, and blood-pressure-raising drugs. All three are taken with food according to their labels. ^{13 14 15}

A note if you've read older articles: current Jatenzo, Tlando and Kyzatrex labels no longer carry the previous blood-pressure boxed warning. The blood-pressure warning itself remains. Removing a box does not remove the monitoring need, and the separate studies above should not be used to rank products. Our oral testosterone guide goes deeper. ^{13 14 15}

Natesto and other nasal sprays

Natesto goes inside your nose, so its label adds a rule the others don't have.

• Oxymetazoline was specifically studied. Given 30 minutes before Natesto in a study, it did not meaningfully change testosterone absorption. That finding is not a blanket recommendation to use Afrin or any decongestant. ¹²
• Most other nasal sprays aren't recommended. Other nasal medicines haven't been studied, so the label doesn't recommend using them with Natesto. Decongestants in the same family as oxymetazoline (sympathomimetic decongestants) are the one exception.
• Allergies can lower absorption. In the Natesto study, symptomatic allergic rhinitis reduced testosterone exposure by about a fifth. ¹²

If you use a steroid nasal spray every day for allergies, raise that before choosing Natesto.

What about compounded testosterone?

Compounded testosterone may be prepared for a patient's needs by a compounding pharmacy. It isn't FDA-approved, and it does not have an FDA-approved product-specific prescribing-information document. Pharmacy instructions are not the same as FDA-reviewed labeling. ⁴⁴

Ask your prescriber which reference they use to screen your other medicines. If they can't tell you, keep asking until someone can.

What changed in 2025 and 2026

Testosterone labels changed a lot recently. Older interaction articles can be out of date.

• February 28, 2025. The FDA requested class-wide label changes: TRAVERSE information, removal of the previous boxed-warning language about increased adverse cardiovascular outcomes, and blood-pressure information. The request is not proof that every published label contains identical updates. ⁴¹
• The 2025–2026 records above. Several products now include TRAVERSE results and blood-pressure study findings; the older-format records do not all reproduce those results. Other boxed warnings, such as Aveed's serious injection-related risks and gels' secondary-exposure risks, are separate and have not simply disappeared. ^{5 7 13}
• June 18, 2026. HHS announced that FDA was requesting additional label updates concerning age-related low testosterone and prostate conditions. A request is not evidence that every product label has already changed. Use the current label for the exact prescription, not the announcement as permission to ignore a warning. ⁴²

---

What about thyroid medicine and other drugs people ask about?

A drug does not have to be named in a testosterone interaction section to matter to your care. Thyroid treatment, PSA-lowering drugs and medicines that suppress your own testosterone need separate review. No short list can clear every antidepressant, supplement or hormone add-on. ^{29 35 19}

Levothyroxine and thyroid labs

Testosterone can change thyroid-hormone binding, and thyroid-replacement needs may change too. Do not assume it affects only a harmless lab number. ^{29 30} The direct dose-change study was small and involved women receiving a different androgen for breast cancer; it does not predict the size of a change in men on TRT.

Labels explain that androgens can lower thyroxine-binding globulin, a protein that carries thyroid hormone in the blood. That can make total T4 read lower while free thyroid hormone remains unchanged in a person with normal thyroid regulation. It does not guarantee an unchanged result or dose requirement in someone taking levothyroxine. ^{1 29}

Ask your thyroid prescriber which tests to repeat after androgen therapy changes. TSH and free T4 can help, but the right interpretation depends on the thyroid condition; TSH alone is not reliable for central, or pituitary-related, hypothyroidism. Do not change levothyroxine based on total T4 alone. ²⁹

Finasteride and dutasteride

The testosterone records reviewed do not name finasteride or dutasteride as a specific drug interaction. In a 2012 JAMA trial in men whose testosterone production had been experimentally suppressed, dutasteride did not significantly blunt testosterone-related changes in fat-free mass or strength. That study is not proof of benefit or safety for every TRT patient. ³⁴

The catch is PSA. These medicines can lower the PSA blood-test result, which changes how it must be interpreted. The dutasteride label reports a reduction of about 50% within 3–6 months. Make sure your TRT prescriber knows which prostate or hair-loss medicine you take; a lower PSA number is not automatic reassurance. ³⁵

Anastrozole

Anastrozole is sometimes added to TRT to reduce the conversion of testosterone to estrogen. That use is off-label in men; its approved indications are for breast cancer in postmenopausal women. ³⁷

In a one-year trial in men aged 60 or older, anastrozole raised testosterone but lowered spine bone density compared with placebo. That trial did not establish a routine benefit from adding it to TRT. If someone adds it to your plan, ask why, what problem it treats, and how bone health will be considered. ³⁶

Antidepressants

The testosterone records reviewed do not name an antidepressant individually. Mayo Clinic's list includes bupropion (Wellbutrin). Ask your pharmacist about your specific drug rather than assuming a whole class is a problem—or that silence in a testosterone label means no risk. ⁵¹

Supplements

FDA does not approve dietary supplements for safety and effectiveness before they are marketed. "Natural" doesn't mean safe to combine. ⁴⁵

Bring the actual bottle or label to your appointment, not just the brand name. Multi-ingredient "testosterone boosters" are the hardest to judge. And to be clear, a booster isn't TRT.

Medicines that lower your own testosterone

Some drugs suppress the body's own testosterone production. These aren't interactions with TRT, but they matter before a diagnosis:

• Opioid pain medicines. The Endocrine Society calls low testosterone a well-recognized opioid side effect.
• Long-term corticosteroids.
• Oral ketoconazole, an antifungal that can inhibit testosterone production; do not assume a shampoo or skin cream has the same effect. ⁶⁰

These medicines are possible causes of low testosterone, not reasons to pretend a low result cannot be real. The clinician should assess them while confirming symptoms, repeated morning results and the underlying cause. Do not stop pain treatment or steroids yourself. ^{19 20}

hCG and enclomiphene

These aren't testosterone, and they aren't interchangeable with TRT. Certain prescription hCG products are approved for selected cases of male hypogonadotropic hypogonadism; adding hCG to TRT specifically to preserve fertility is off-label. Enclomiphene is not FDA-approved. Neither approach guarantees preserved sperm production or pregnancy. ^{38 39 40}

If children matter now or soon, start with a reproductive urologist rather than assuming an add-on cancels out TRT's effect on sperm. Our guide to hCG with TRT explains the evidence and limits. ¹⁹

---

Does taking another medicine mean you can't get TRT?

No. Several common interactions call for monitoring rather than an automatic ban, but the exact drugs and your health history can change the answer. Don't stop a prescribed medicine to make yourself a better TRT candidate. ^{4 19}

What the list really looks like

Sources for the decision table: ^{4 19 25 17 18}.

Never stop a medicine to "qualify"

We'll say this plainly because it matters. Don't drop a blood thinner, a diabetes medicine, or a blood pressure pill to make a TRT intake go smoother. The medicine you already take is protecting you from something real.

---

What should you tell your prescribers before and during TRT?

Give every prescriber your full list: prescriptions, over-the-counter medicines, and supplements. Tell your TRT prescriber who manages each condition, and agree on a review whenever testosterone or another medicine starts, stops or changes. Warfarin labels specifically call for closer INR checks when androgen therapy starts or stops. ^{4 13}

The six things to say (copy these)

1. "I take [medicine] for [condition], prescribed by Dr. [name]."
2. "I'm starting testosterone on [date]. The product is [exact name]."
3. "Should we check my INR / blood sugar / blood pressure / hematocrit more often, and when?"
4. "I have / have not had a blood clot, and I do / don't have a clotting disorder."
5. "I sometimes take [decongestants / ibuprofen / naproxen]."
6. "I have surgery or a procedure coming up on [date]."

Then make one call: let the prescriber who manages your blood thinner or diabetes know the TRT start date. That single step closes the gap most people fall through.

Before surgery or a procedure

Tell the surgeon about both testosterone and any blood thinner. Your surgeon and the prescriber who manages your blood thinner decide what to hold and when. Don't stop either on your own.

If you're using an online TRT clinic

An intake form is only as good as what you write on it and who reads it. Before you pay, ask any clinic:

• Which licensed clinician or pharmacist reviews my medication list, including any alerts from software?
• Do you check hematocrit before I start, and again after?
• How often are follow-up labs?
• Will you send my results to my primary care doctor or cardiologist?

If a clinic can't answer those clearly, that's your answer.

Build your medication review in two minutes

Use this TRT Medication Review Prep worksheet to make a question list you can copy or print and bring to your appointment. It is a worksheet, not an automated interaction checker.

The worksheet cannot say a combination is “safe” or “unsafe.” The evidence for its questions is in the label matrix and medication sections above. You can use it without entering health details into a website.

Not sure who should review your list: your doctor, a specialist, or a TRT program? Start with the clinician who manages your highest-risk medicine or condition. For general care-route questions, use Find My TRT Path →. It is educational and cannot diagnose low testosterone, check drug interactions, determine medical eligibility, or guarantee a prescription.

---

Which TRT care route fits if you take other medicines?

If your blood thinner is for a past clot or clotting disorder, start with your hematologist or anticoagulation prescriber. For other medication profiles, online or local care may be appropriate, but a lab panel alone does not establish fit. The clinician must review your exact medicines, diagnosis and risks, and coordinate any needed monitoring. ^{19 4}

Find yourself here

• Blood thinner after a DVT, PE, or clotting disorder: Specialist first. An endocrinologist or urologist may need to work with your anticoagulation clinician. The requirement is specialist assessment and coordination, not a promise that a particular delivery model is automatically safe. See who should not take TRT.
• Blood thinner for AFib or a valve: Get your cardiologist's review first. Then choose a care team that can share records and follow the agreed plan. Do not group mechanical-valve treatment with routine DOAC use. ^{17 18}
• Insulin, a sulfonylurea, or an SGLT2 inhibitor: Coordinate with your diabetes prescriber. The TRT clinician needs a glucose and hematocrit plan that fits the exact medicines. ^{7 25}
• Blood pressure medicine, occasional NSAIDs, or short prednisone courses: Online or local care may fit after review. Ask how the team handles blood pressure, fluid retention and medication changes. ⁴
• Low testosterone not confirmed yet: Confirm it first. The Endocrine Society calls for compatible symptoms or signs plus consistently low testosterone, confirmed with repeat morning, fasting testing and appropriate assays. No single number or symptom checklist diagnoses low T on its own. ¹⁹
• Trying to have a child soon: Testosterone can lower sperm production. Raise fertility before any TRT program, and consider a urologist or reproductive urologist first. The Endocrine Society recommends against starting testosterone when near-term fertility is planned. ¹⁹

If your clinician says online care is an option

Disclosure: TRT Provider Guide has an affiliate relationship with Hone Health and may earn a commission through some provider links. It does not change what we verify, who we tell to look elsewhere, or our method, How We Review TRT Providers. Read our affiliate disclosure.

For this page, lab coverage matters—but it is not enough by itself. A clinic must also say who reviews your medicines, who acts on results, and who coordinates with your anticoagulation, diabetes or thyroid prescriber. An INR plan is not the same as a general wellness panel.

Hone Health publishes a biomarker list. It includes:

• hematocrit, hemoglobin, and red blood cell count
• glucose
• kidney and liver markers
• TSH and T4

Those are several of the blood counts and chemistry measures discussed on this page. These are provider-stated offerings, not independent testing of Hone's clinical service. Hone's homepage advertises testing every six months for Basic and every 90 days with follow-ups for Premium. Basic physician consultations require an additional purchase; Premium advertises included follow-ups. ^{52 53}

Here's the trade-off. A published panel does not prove that a clinic will manage your drug interaction. The general biomarker list is not a promise of INR monitoring or a schedule tailored to a newly started medicine. Ask which tests your proposed plan includes, who handles abnormal results, and what any extra checks cost before you pay.

Hone does publish a state-by-membership availability page, and its help center discusses testosterone cypionate. Availability and the exact prescribed product still need confirmation for your plan; its help center also says specific brands or manufacturers cannot be guaranteed. An FDA-approved product and a compounded preparation are not interchangeable claims. ^{54 55 56}

Does that sound like the information you need before comparing programs? Review Hone Health's published biomarkers →. This is a lab-disclosure example, not a finding that Hone is the best or safest choice for your medicines.

Still weighing online against local care? Find My TRT Path can help you explore general care questions; it does not replace the medication review.

---

What did we actually verify?

This page compares named prescribing-information records and separates label warnings from research findings and provider claims. It does not claim to have tested a clinic, screened an individual patient, or counted every testosterone product on the U.S. market.

What we actually verified

Date checked: October 27, 2026

What we read:

• The interaction, warning and relevant laboratory-test sections of the 15 testosterone records linked in the matrix, plus the separate Methitest/methyltestosterone record
• The current manufacturer-hosted Eliquis and Xarelto prescribing information
• The FDA's February 28, 2025 labeling notice and HHS's June 18, 2026 announcement
• TRAVERSE results reported in prescribing information and the original trial report's abstract
• The Endocrine Society's testosterone guideline and July 2026 statement
• The primary research reports linked below, including the SGLT2/testosterone cohort, injection-vaccine review, thyroid-treatment study and conference-reported GLP-1 findings
• Current federal telemedicine text, Hone's public biomarker and plan pages, and its state-availability and product help pages

Verified label and research facts:

• Which issues the selected labels explicitly name—and where they are silent
• The difference between a warfarin INR warning and a DOAC-specific assessment
• The eight reported ambulatory blood-pressure changes, without ranking separate studies as if they were head-to-head
• The TRAVERSE figures and study population
• The SGLT2 cohort's adjusted odds ratios, not a claim of causation or an individual's probability

Provider-stated, not independently tested by us:

• Hone's published biomarker list, plan testing cadence and consultation features
• Hone's state-by-membership availability and product disclosures

Limits:

• No patient-level drug combination is cleared by this article or its worksheet.
• The matrix is not an exhaustive market or availability census. An absent label entry does not prove no interaction.
• We did not buy treatment, inspect a patient's prescription, verify a dispensing pharmacy for an individual order, or test a provider's response to an abnormal result.
• We did not confirm that Hone would provide individualized INR or other interaction-specific follow-up for a particular patient. That needs a direct clinical answer before payment.

Editorial judgment: The care-route guidance and the recommendation to seek coordinated medication review are our conclusions from the cited evidence. A public lab list is not a provider safety rating.

---

Frequently asked questions

These answers summarize the medication-specific evidence above. They do not replace a pharmacist or prescriber checking your exact products and health history.

Does testosterone interact with warfarin?

Yes. Testosterone can change how strongly warfarin works, and labels call for more frequent INR/PT checks, especially when testosterone starts or stops. Your warfarin prescriber should know your start date and set the monitoring plan. ^{4 13}

Can you take testosterone with Eliquis?

The labels reviewed do not name a testosterone–apixaban interaction, but that is not proof of no interaction. Routine INR checks do not measure Eliquis's anticoagulant effect. Ask the clinician managing your Eliquis to review the combination and why you take it; a prior clot or thrombophilia needs particular attention. ^{17 4 19}

Can you take testosterone with Xarelto?

The labels reviewed do not name a testosterone–rivaroxaban interaction. The prescriber who manages your Xarelto should still assess the exact combination and testosterone's clot and hematocrit warnings. Do not assume label silence means personal clearance. ^{18 7}

Does testosterone increase bleeding?

Testosterone can increase sensitivity to warfarin, which can raise bleeding risk if its effect is not monitored. Other blood thinners need their own assessment. Adding aspirin to an anticoagulant can raise bleeding risk, so don't add it on your own. ^{1 17 18}

Can testosterone cause blood clots?

FDA labels warn about clots in the legs and lungs. In TRAVERSE, pulmonary embolism happened in 0.9% on testosterone gel versus 0.5% on placebo. An observational study found an early-use association, but that does not establish the same timeline or risk for everyone. ^{7 22}

Should I take aspirin on TRT to thin my blood?

Not on your own. Aspirin doesn't lower hematocrit, which is the "thick blood" number TRT can raise. A clinician should investigate and manage high hematocrit, which may involve changing treatment or phlebotomy. Do not self-treat it with aspirin or blood donation. ²⁰

Can you take prednisone with testosterone?

The combination needs review because corticosteroids and testosterone can add to fluid retention, particularly with heart, kidney, or liver disease. Watch for swelling and tell your TRT prescriber about any steroid course. ^{4 7}

Does testosterone interact with insulin or metformin?

The testosterone records reviewed warn that blood sugar may drop and insulin needs may change. They do not name metformin specifically; metformin alone rarely causes low blood sugar. Ask your diabetes prescriber for a glucose plan, especially if you also use insulin or a sulfonylurea; do not adjust doses yourself. ^{7 57}

Can you take testosterone with Jardiance?

A clinician may prescribe both, but the combination needs hematocrit review. In a study of 53,971 veterans with diabetes, combined SGLT2 inhibitor and testosterone use was associated with about 2.5 times the adjusted odds of erythrocytosis compared with testosterone alone. Ask who will arrange baseline and follow-up checks. ²⁵

Can you take testosterone with Mounjaro or Zepbound?

There is no testosterone-specific interaction established by the labels reviewed, but that is not a blanket safety guarantee. Tirzepatide and semaglutide can affect stomach emptying, oral-drug absorption and glucose management. Tell both prescribers, especially if you use oral testosterone, warfarin or insulin. ^{31 32}

Can you take testosterone if you have AFib?

Talk to your cardiologist first. In TRAVERSE, atrial fibrillation happened in 3.5% of men on testosterone versus 2.4% on placebo. That finding came from a selected cardiovascular-risk population and is not personal clearance or a prediction. If you take a blood thinner for AFib, the warfarin and DOAC answers above also apply. ^{7 21}

Does testosterone affect thyroid medicine?

It can. Androgens can lower a thyroid-hormone carrier protein, and thyroid-replacement requirements may change. Your clinician should interpret TSH and free T4 for your particular thyroid condition rather than changing levothyroxine based on total T4 alone. ^{29 30}

Does testosterone interact with cold medicine?

Some testosterone labels (Xyosted, Jatenzo, Tlando, Kyzatrex) warn that decongestants and some pain relievers can raise blood pressure. Combined with testosterone, they may raise it more. Ask a pharmacist about the exact cold or pain product and the blood-pressure plan that fits your treatment. ^{4 13}

Does compounded testosterone have the same interactions?

Compounded testosterone isn't FDA-approved and has no FDA-approved product-specific prescribing information. That does not mean no interactions. Ask your prescriber and pharmacist which references they use to screen your exact preparation and other medicines. ⁴⁴

Can I get TRT online if I take other medicines?

Sometimes, after proper diagnosis and a clinician's medication review. Testosterone is a Schedule III controlled substance requiring a valid prescription. As checked October 27, 2026, the federal temporary extension runs through December 31, 2026 and permits qualifying DEA-registered practitioners to prescribe Schedule II–V medicines without a prior in-person examination when its conditions are met. For testosterone, that ordinarily means a qualifying audio-video encounter, a legitimate medical purpose, and compliance with applicable federal and state law—not just a questionnaire. A provider may still require an in-person visit. ^{4 46 47}

---

Sources

Label records and public pages were checked October 27, 2026. Dates below distinguish label revisions, older research and current provider statements; a historical study is not being represented as a new study.

1. Depo-Testosterone prescribing information, September 2025; drug interactions and laboratory tests.

2. Testosterone cypionate, selected generic prescribing information, June 2025.

3. Testosterone enanthate, selected generic prescribing information, June 2025.

4. Xyosted prescribing information, July 2025; sections 5, 6 and 7.

5. Aveed prescribing information, July 2025; sections 5, 6 and 7.

6. Testopel prescribing information, July 2025.

7. AndroGel 1.62% prescribing information, October 2025; interactions, blood-pressure study and TRAVERSE results.

8. AndroGel 1% prescribing information, October 2025.

9. Testim prescribing information, July 2025.

10. Vogelxo FDA prescribing information, July 2025; blood-pressure study and interactions.

11. Testosterone gel 1.62%, selected generic prescribing information, August 2025.

12. Natesto prescribing information, July 2025; sections 7 and 12.3.

13. Jatenzo prescribing information, September 2025; sections 5, 6 and 7.

14. Tlando prescribing information, February 2026.

15. Kyzatrex prescribing information, August 2026.

16. Methitest (methyltestosterone), DailyMed record updated May 31, 2025; a related androgen, not a testosterone formulation.

17. Eliquis manufacturer prescribing information; sections 5, 7 and 12.2; accessed October 27, 2026.

18. Xarelto manufacturer prescribing information; sections 5.8 and 7; accessed October 27, 2026.

19. Endocrine Society: Testosterone Therapy for Hypogonadism, clinical-practice guideline recommendations.

20. Bhasin S, et al. Testosterone therapy in men with hypogonadism: Endocrine Society guideline. JCEM, 2018; monitoring table and erythrocytosis discussion.

21. Lincoff AM, et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE). NEJM, 2023.

22. Martinez C, et al. Testosterone treatment and risk of venous thromboembolism. BMJ, 2016; observational case-control study.

23. Testosterone replacement therapy and vascular thromboembolic events: a systematic review and meta-analysis. Asian Journal of Andrology, 2024.

24. Ory J, et al. Secondary polycythemia in men receiving testosterone therapy and first-year cardiovascular/thromboembolic events. Journal of Urology, 2022.

25. Gosmanov AR, et al. Increased risk of erythrocytosis with combined SGLT2 inhibitor and testosterone therapy. Journal of Endocrinological Investigation, 2024.

26. Effects of SGLT2 inhibitors on haematocrit and haemoglobin levels: a meta-analysis. Journal of Cellular and Molecular Medicine, 2022.

27. Schumacher and Gosmanov. Hemochromatosis gene mutation in persons developing erythrocytosis on combined testosterone and SGLT2 inhibitor therapy. 2022 case series.

28. Caldeira D, et al. Low risk of haematomas with intramuscular vaccines in anticoagulated patients: systematic review and meta-analysis. Thrombosis Journal, 2022.

29. Levothyroxine sodium prescribing information; thyroxine-binding globulin and thyroid-test interpretation.

30. Arafah BM. Decreased levothyroxine requirement in women with hypothyroidism during androgen therapy for breast cancer. Annals of Internal Medicine, 1994; small, different-patient-population study.

31. Mounjaro (tirzepatide) prescribing information; sections 7.1 and 7.2.

32. Ozempic (semaglutide) prescribing information; drug interactions and gastric emptying.

33. Endocrine Society, ENDO 2025 report: testosterone changes in 110 men using GLP-1-based treatment without testosterone therapy.

34. Bhasin S, et al. Testosterone supplementation with and without dutasteride: randomized trial. JAMA, 2012.

35. Dutasteride prescribing information; effects on PSA.

36. Burnett-Bowie SA, et al. Aromatase inhibition and bone mineral density in older men. JCEM, 2009.

37. Anastrozole prescribing information; approved indications.

38. Novarel (chorionic gonadotropin) prescribing information; selected cases of male hypogonadotropic hypogonadism.

39. FDA Pharmacy Compounding Advisory Committee, June 8, 2022 transcript, pages 53–54; enclomiphene approval status.

40. Operation Supplement Safety: Clomiphene and Enclomiphene—Drugs, Not Dietary Supplements.

41. FDA, February 28, 2025: class-wide labeling changes for testosterone products.

42. HHS, June 18, 2026: FDA requests updates to testosterone therapy labeling.

43. Endocrine Society, July 2026: statement on testosterone replacement therapy.

44. FDA: Understanding the Risks of Compounded Drugs.

45. FDA: Information for Consumers on Using Dietary Supplements.

46. 42 CFR Part 12: telemedicine flexibilities, including conditions and the December 31, 2026 endpoint.

47. DEA/HHS: Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities, Federal Register, December 31, 2025.

48. CDC: About Venous Thromboembolism—signs, symptoms and when to seek care.

49. FDA Oxandrin (oxandrolone) historical prescribing information, 2003, page 2; warfarin study—not a testosterone study.

50. Drugs.com: Testosterone Interactions; database display checked October 27, 2026, not used as the authority for medical conclusions.

51. Mayo Clinic: Testosterone, intramuscular/subcutaneous; interaction-list display checked October 27, 2026.

52. Hone Health: published biomarker list; provider-stated information checked October 27, 2026.

53. Hone Health: published Basic and Premium plan features; provider-stated information checked October 27, 2026.

54. Hone Health: Service Availability by State (2026); provider-stated, updated September 4, 2026.

55. Hone Health: Testosterone Cypionate for Men; provider help-center product information.

56. Hone Health: Why We Cannot Guarantee Specific Brands or Manufacturers.

57. Metformin hydrochloride prescribing information; hypoglycemia with usual use alone and combination therapy.

58. Jardiance (empagliflozin) prescribing information; approved indications.

59. American Heart Association: Managing High Blood Pressure Medications; OTC medicines that can raise blood pressure, reviewed August 14, 2025.

60. Ketoconazole tablets prescribing information; testosterone suppression with oral treatment.

---

Still not sure which TRT care route fits you? Use our free Find My TRT Path tool.

---